Epidural analgesia in active management of labor

Abstract

Objectives. To examine the determinants of epidural analgesia in the active management of labor. To examine the association of epidural with instrumental delivery and cesarean section. Study Design. Observational study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A thousand consecutive nulliparous women at term, were assessed.Results. Requests for epidural anesthesia were predominantly expressed at the time the patient was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caused labor to be subjectively more arduous. In induced labor, the same observation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when the incidence of operative delivery was adjusted for the use of oxytocin, the significance between patients with epidural versus the others abated.Conclusion. The use of oxytocin in active management of labor results in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.